The principal aim of this proposal is to determine whether or not adherence to current standards of cancer screening practice in an asymptomatic population can be enhanced through the implementation of a patient reminder system coupled with a physician and patient awareness program. Specifically, it is our intention to explore whether or not breast cancer screening referral rates can be increased through the implementation of a coordinated set of interventions designed to 1) increased patient demand for the delivery of breast cancer screening services; 2) enhance physician awareness of the current standards of practice with respect to breast cancer screening; and 3) provide a system based, physician surrogate patient reminder system designed to alert female patients when periodic breast cancer screening is due. We will measure the success of these efforts by examining changes in the age specific and age adjusted breast cancer screening referral rates for women over forty in each of two groups. As a secondary objective will be to assess the feasibility and acceptability of the implementation of such a program with respect to several important variables: physician and patient satisfaction and cost. The study will be conducted in a network Independent Practice Association (IPA) The Tufts Associated Health Plan (TAHP) consisting of 16 IPAs with approximately 800 primary care physicians serving over 90,000 patients in the Boston Metropolitan area. We believe that if successful in this setting a physician surrogate patient reminder and education system would be equally effective with other screening efforts.